The comments come as the association of GPs prepares to lodge its pre-budget submission to the Morrison government, calling for «significant and immediate» investment to safeguard general practice.
The submission, seen by the Sydney Morning Herald and The Age, projects a decline in the rate of bulk billing if Australia continues on its current trajectory, while the average out-of-pocket cost for a standard, non-bulk-billed GP visit would hit $40.69 in the next financial year.
«Over the last five years, average patient out-of-pocket costs for a GP visit have increased by 30 per cent,» the submission says.
Dr Nespolon said GPs had «no choice» but to increase the gap fees they charged if Medicare rebates did not match the rising cost of running a medical practice.
And he said more GPs would start charging patients they would otherwise bulk bill.
«My guess is that people will start charging children first, in the sense that they won’t be bulk billed automatically,» Dr Nespolon said.
«Then the next step will be the non-aged pensioners.»
Ultimately, he said, if the situation did not improve, aged pensioners could be turned away.
While intended as a temporary budgetary repair measure, Labor’s indexation freeze was cemented by the Coalition under Tony Abbott’s prime ministership and continued until Health Minister Greg Hunt lifted it last year, increasing the standard GP rebate by 55¢.
Dr Nespolon said the Morrison government «should be embarrassed» at the paltry increase, which lifted the rebate from $37.05 to $37.60 last July.
GPs want this to be increased by at least $4, placing the rebate at the level it would have reached had it been indexed against the consumer price index, rather than the wage price index.
If this approach had been taken since 2005, the rebate for a standard GP consultation would have risen to $41.84 in 2017-18, according to analysis by the Royal Australian College of General Practitioners.
Dr Nespolon said it was «inevitable» that out-of-pocket expenses would continue to rise unless indexation reflected the reality of medical inflation.
«This is an industry that is under extreme pressure,» he said.
If GPs could not earn a decent living, he said, the profession would not be able to attract enough doctors to replace its rapidly ageing workforce.
«And if you think you’re going to run a healthcare system in this country inexpensively by not having a vibrant general practice or primary care sector, you’ve got rocks in your head,» he said.
A Productivity Commission report on the nation’s health system last week revealed that Australians made three million «avoidable» trips to hospital emergency rooms last financial year, because of difficulties securing GP appointments.
The report found that almost one million Australians had delayed going to the GP — or did not go at all — due to cost over the 12-month period, while more than a quarter of patients were unable to get an appointment within 24 hours.
About 31 per cent of Australians or 7.6 million people are paying a gap fee when they go to the GP.
While 86 per cent of GP attendances were bulk billed in 2017-18, many of the visits were by chronically ill and elderly patients who need frequent trips to the doctor and hold pension cards.
Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.